CARING HEALTH CARE

What is palliative care?

• Palliative care — from the Latin “palliare,” which means “to cloak” — grew out of the hospice movement of the 1970s.

• It helps patients with life-limiting illness in their final years, guiding them through difficult choices in planning for care and treatment, and in managing symptoms and social and psychological issues.

• It sharply contrasts in cost and patient experience with the prevalent end-of-life care in hospitals.

Fighting stage-four ovarian cancer, Carol Delzatto has more doctor appointments than she cares to count. But this day, she is beaming as Dr. Pamela Sutton comes into sight, greeting her patient and calling her beautiful. Delzatto looks forward to her monthly meeting with the palliative care doctor, where she won’t be pricked and won’t be rushed, just listened to and offered help.

Hospitals across the country have been adding programs in palliative care — which focuses on treating pain, minimizing side effects, coordinating care among doctors and ensuring the concerns of patients and their families are addressed — at a feverish pace. The field has expanded so rapidly that a majority of American hospitals now have palliative programs, to the delight of patients who say they’ve finally found relief and a sympathetic ear.

Palliative care has its roots in the 1970s, but it was slow to grow. Several pieces of research helped to advance the cause, though, showing widespread untreated pain in hospitals and nursing homes and the positive impact palliative programs had on such patients.

“She’s not writing. She is just looking at me and listening and feeling,” said Delzatto, 67, during her visit to Broward General Medical Center in Fort Lauderdale, Fla., where Sutton helped start the palliative care program more than a decade ago.

Differs from hospice care

Palliative care is not hospice, which also focuses on emotional support and relieving symptoms for people in the final six months of a terminal illness. Palliative patients may have several years left. But neither is it a hospital, where aggressive care at each crisis can cost tens of thousands of dollars.

And it does not require giving up the chase for a cure, as hospice does. In fact, palliative care can ease illnesses that aggressive treatments often trigger.

Dr. Diane Meier of Mount Sinai Medical Center in New York, who directs the Center to Advance Palliative Care, says one of the discipline’s greatest benefits is that it looks at the patient as a whole.

“Patients see a different person for every single part of their body or every problem. The patient as a whole person gets lost,” said Meier, who won a MacArthur fellowship for her palliative work. “The patient is a person, not a problem list, not a list of different organ systems with different problems, not a list of different diseases. So we end up serving in a quarterback role for the entire medical system.”

In 2000, there were 658 palliative programs in hospitals, according to the Center to Advance Palliative Care, representing about one-quarter of American hospitals. By 2009, about 63 percent of hospitals had palliative teams, with a total of 1,568 programs. The field is expected to continue growing as awareness and acceptance spreads, just in time to help baby boomers — the 78 million Americans born between 1946 and 1964 — as they age and begin developing more serious illnesses.

Team help enlisted

Though the programs and their scope vary widely, a common scenario might look like this: A patient is diagnosed with lung cancer, and a palliative care team’s help is enlisted from the start, working alongside oncologists and other specialists. The palliative team may include doctors and nurses as well as a social worker and chaplain. Together, they coordinate care among the many medical professionals, have long consults with the patients and their families to answer questions, and may preventively prescribe medications for likely side effects of treatment, from pain to constipation to nausea.

The palliative team has a clear vision of the patients’ goals and personal philosophies and, depending on these factors, might help steer them away from treatments that are determined to be more painful than they’re worth.

Besides cancer, the team’s help is commonly employed for treatment of heart and liver failure, HIV and AIDS, emphysema, sickle cell anemia, chronic obstructive pulmonary disease and a wide variety of other illnesses.

Misconceptions, resistance

Palliative teams are sometimes met with doubt by both patients and their medical colleagues. Dr. Timothy Quill, a palliative care doctor at the University of Rochester Medical Center and president of the American Academy of Hospice and Palliative Medicine, concedes that patient recognition of what palliative care is remains relatively low and that resistance to the field remains among doctors untrained in the field.

Aside from misconceptions about palliative care being non-curative pain relief for patients destined to die, specialists may find a palliative team helps a patient reach a treatment decision that doesn’t offer the most payment. Quill offers an example of a heart-failure patient who may be considering getting a ventricular assist device.

“The economic incentives clearly favor doing aggressive medical interventions like this,” Quill said. “Palliative care, it’s all conversation. And conversation is not compensated in the same way that doing procedures is in our system right now.”

Meier says resistance to palliative care tends to be generational, with many younger doctors embracing the field. Research on the subject has also helped prove its worth, particularly a 2010 study published in the New England Journal of Medicine.

That widely publicized report looked at terminal lung cancer patients and found patients who received palliative care as soon as they were diagnosed were in less pain, happier and more mobile than those who didn’t receive such care, and the patients ultimately lived nearly three months longer.

Even with such scientific backing, and generally rave reviews from patients, even palliative care’s most-ardent backers admit it would not have spread as it has without showing cost savings to hospitals. Because a result of palliative care is shorter hospital stays, it can cut costs since many insurance plans pay a flat reimbursement for a treatment, not for the length of stay.

If a bed is freed up sooner, that means another paying customer can occupy it.

Impact hard to pinpoint

A study of patients — published in March in Health Affairs — showed a $7,000 savings per hospital admission for palliative care patients compared with those without palliative care.

Sutton is focused this day on Delzatto, asking her about her sleep and bathroom patterns, and addressing her pain by writing prescriptions. Before seeing Sutton, the patient said she was suffering so greatly she was barely able to move. Now, she’s able again to live fairly normally, browsing garage sales with a neighbor and walking the mall.

“The oncologists are focusing on chemo, the patients are focusing on cure, and I think the conversations about comfort aren’t happening,” Sutton said.